UnitedHealthcare Plan Gives Physicians Final Say on Care

MINNEAPOLIS—United-Healthcare, a subsidiary of UnitedHealth Group, has announced that it is further advancing its philosophies on consumer choice and physician autonomy through an initiative called Care Coordination. The new initiative makes obsolete certain programs associated with traditional managed care, such as preauthorization for inpatient hospital procedures.

Under the new system, physicians will be required to notify the company when patients enter the hospital, require home care, or need expensive procedures or medical equipment, but no request for treatment or services covered in the member’s contract will be denied. The company may request more information or suggest other less costly treatments, but the final decision on care will lie with the physician.

The new Care Coordination program is intended to enhance patient care and keep costs down by offering patients education about their illness and closely coordinating and monitoring the care of members who have chronic and complicated medical conditions.

The program involves seven core clinical activities: health education, admission counseling, inpatient care advocacy, readmission prevention, disease management, complex illness support, and pharmacy management.

“Millions of dollars are spent every year on reviewing the treatment decisions made by physicians,” said Dr. Archelle Georgiou, chief medical officer for UnitedHealthcare. “Over the last decade, we have seen the value to patients and employers of these efforts diminish as runaway health care costs have been slowed and services expanded. The vast majority of our reviews support the physician’s clinical decision, so it makes sense to focus on other programs and efforts.”

To help doctors and patients reach the best decisions, UnitedHealthcare is leveraging its database of more than 14 million patients to provide its doctors with data comparing the treatments they are recommending for their patients against national treatment norms.

The Care Coordination initiative was begun in 1998 and tested in six markets prior to national implementation. Results from these markets indicated that Care Coordination was able to improve the entire health care experience without additional cost to the employer or member.

UnitedHealthcare has been a leader in the managed care industry in providing innovative programs designed to increase consumer choice. The company offers health care plans that allow members to see a specialist without a referral from their primary care physician and that provide coverage for cancer patients enrolled in NCI-approved clinical trials (see Oncology News International, November 1999, page 1).